Why you should care

Home to universal health care, a generally friendly people and a charming — some might sexy — prime minister, Canada is, all things considered, a decent place to hang your hat. But one Canadian province is facing a deadly serious health crisis — one that’s expected to get worse.

In 2016, Diabetes Canada found that:

In Newfoundland and Labrador, 35.4 percent of the adult population has diabetes or prediabetes — the highest rate of any province in Canada and one of the highest rates in the world.

The health organization compiled information from Statistics Canada, the Public Health Agency of Canada and the National Diabetes Surveillance System, and the data shows a stark reality: The prevalence of diagnosed Type 1 and Type 2 diabetes in Newfoundland and Labrador — which form a single province — has gone up 44 percent in the past decade, and Diabetes Canada predicts it will rise another 25 percent in the next 10 years. “The rates are increasing very rapidly,” says Lisa Matte, Atlantic regional director for Diabetes Canada. “It’s not a good picture.”

The national portrait is also cause for concern. The Canadian average is 25 percent, and several other provinces and territories are up around 30 percent. From a global perspective, the number in Newfoundland and Labrador is higher than the 30 percent rate of diabetes and prediabetes in the U.S., but still lower than the estimated 47 percent of people in China who are affected by one of these conditions.

While the Canadian data factors in both Type 1 and Type 2 diabetes, the majority of people on the island of Newfoundland and mainland Labrador suffer from Type 2. “Type 1 is considered an autoimmune disease, so not much can be controlled or prevented,” says Matte. “But Type 2, while it tends to be genetic, is activated by modifiable risk factors, including an unhealthy diet, a lack of physical activity and being overweight or obese.”

They have this perfect storm over there.

Lisa Matte, Atlantic regional director, Diabetes Canada

When it comes to these particular risk factors, Newfoundlanders and Labradorians have the cards stacked against them. The province has the country’s highest rate of overweight and obese adults — 67 percent — and its smoking rates are higher than anywhere else in Canada. “They have all the serious factors that contribute to a higher prevalence of diabetes,” Matte says. “They have this perfect storm over there.”

Newfoundland faces other factors as well. The risk for developing diabetes increases with age, especially after 45. Newfoundland and Labrador have the oldest median population of any province in Canada — 46 years — and 21.2 percent of the population is 65 or older, according to the 2016 Canadian census.

There’s also very little migration in and out of the region, making the population genetically isolated. “If there are genetic predispositions to diabetes in Newfoundland, they’re not being diluted by mixture from other genes,” says Hertzel Gerstein, an endocrinologist and professor at McMaster University in Ontario. Because of this genetic isolation, Newfoundland has been at the center of several studies aiming to identify the genes implicated in common diseases. Research conducted in the early 2000s found that Newfoundland has one of the world’s highest incidences of Type 1 diabetes. The exact cause of the disease is unknown, but researchers believe it’s a combination of genetic and environmental factors, like exposure to certain viruses or living in a cold climate.

The elevated rate of Type 2 in Newfoundland and Labrador has not been studied as extensively, but Gerstein notes a high prevalence of diabetes in other genetically isolated populations like the Pima Indians in southwest Arizona and some First Nations in northern Ontario. If there’s a genetic predisposition for diabetes in Newfoundland, it’s likely triggered by cultural influences, Gerstein says, “that discourage physical activity and encourage the consumption of high-energy, high-density food.”

For more than a decade Diabetes Canada has promoted programs like the Healthy Students and Healthy Schools initiatives, and the Provincial Food and Nutrition Framework and Action Plan to get locals moving more and eating right. And it works closely with the provincial government to create a diabetes strategy, including improved access to medical care and diabetic supplies like insulin in the predominantly rural region.

Still, the increasing rate of diabetes here illustrates how challenging it can be to change lifestyles. At the current rate, it’s likely to take several decades to lower the prevalence of a disease that darkens the future of an otherwise sunny northern nation.